Commentary on the economic , geopolitical and simply fascinating things going on. Served occasionally with a side of snark.

Monday, February 10, 2014

Obamacare updates - Week of February 9 , 2014 - February 15 , 2014........ Obamacare Employer Mandate Delayed For Companies With Under 100 Employees ........ Four Pinocchios to Durbin for claiming 10 million additional insured under ObamaCare ......... Is the new Healthcare.gov contractor worse than the first?

2/14/14......

Insurers: At least 20% of new ObamaCare sign-ups failed to pay their first premium on time

POSTED AT 11:21 AM ON FEBRUARY 14, 2014 BY ALLAHPUNDIT

So Bob Laszewski was right. Fully one-fifth of the new enrollment numbers that HHS has been waving around are bogus. Their target for the end of January was 4.4 million sign-ups; a few days ago, they told the country they’d made it three-quarters of the way there with 3.3 million. In reality, once the deadbeats are bounced from the rolls by their new insurers, they’ll be in the ballpark of 2.6 million, or 60 percent of their target. And that’s after HHS pressured insurers to extend the payment deadline from December 31 into January, hoping that a little more time for slackers would pad the enrollment figures even more.

Is it “only” 20 percent who haven’t paid, though, or is the actual number even bigger? The Times is guesstimating based on what they’re being told by different insurers, but read down into the piece and you’ll see that the biggest companies are seeing payment rates below 80 percent — another detail flagged by Laszewski when he wrote about this a few days ago. Eighty percent is probably the best-case scenario:

Matthew N. Wiggin, a spokesman for Aetna, said that about 70 percentof people who signed up for its health plans paid their premiums. For Aetna policies taking effect on Jan. 1, the deadline for payment was Jan. 14, and for products sold by Coventry Health Care, which is now part of Aetna, the deadline was Jan. 17…

Kristin E. Binns, a vice president of WellPoint, said that 76 percent of people selecting its health plans on an exchange had paid their share of the first month’s premium by the due date of Jan. 31. The company had received more than 500,000 applications for individual coverage through the exchanges in 14 states, she said…

One big company, Humana, said it had received 200,000 applications for insurance through the exchanges. “About 75 percent of the people paid, and 25 percent did not pay,” said Thomas T. Noland Jr., a senior vice president there. Customers had until Jan. 31 to pay for coverage that took effect on Jan. 1.

What’s the actual payment rate? If it’s 70 percent rather than 80, then suddenly we’re very close to HHS being only halfway to their 4.4 million target at this point.

At least one insurer has now extended the December 31 deadline for premiums to February 15 to delay having to cull their new ObamaCare-friendly consumer base for as long as possible. Note this bit too:

Mark T. Bertolini, the chief executive of Aetna, said last week that the company had 135,000 “paid members,” out of 200,000 who began to enroll through the exchanges. “I think people are enrolling in multiple places,” he said in a conference call. “They are shopping. And what happens is that they never really get back on HealthCare.gov to disenroll from plans they prior enrolled in.”

In other words, John Smith signs up for Aetna’s coverage on Healthcare.gov but waits before paying his first premium; then he sees a cheaper plan at Humana and signs up directly with that company, making his first payment on time. He’s paid up — but he’s still on the books at Aetna as a deadbeat. Or maybe he signs up for a different Aetna plan than he originally chose, leaving him with two separate accounts at Aetna and paid up on only one of them. However you slice it, there are bogus “enrollments” being counted by HHS that are going to end up being canceled soon. How many?

Here’s another data point from my pal Karl. Ask the state exchanges what sort of payment rates they’re seeing and some will tell you it’s a lot lower than 80 percent:

Washington and Wisconsin have reported that barely half of those signing up submitted payments. But the paying portion is 66% in Nevada, 80% in Vermont and 85% in Rhode Island.

Even if 85% were the national average, though, it would still cut ObamaCare’s paid enrollment by a half million to 2.8 million vs. a March 31 goal of 7 million.

It’s possible that paid enrollees represent an even costlier patient population than the updated national sign-up figures suggest.

That last bit is an excellent point. If you had to guess what sort of enrollee would be scrupulous about getting his first premium in on time, what would you guess? Would it be the “young healthy” who signed up on Healthcare.gov in December to keep his options open but who’s ambivalent about popping for coverage this year because he’s not earning much? Or would it be someone who knows they’ll need expensive medical treatment this year and wants to be absolutely certain that their coverage is in effect? In other words, not only are insurers going to have to thin their risk-pool herd for nonpayment, but it may be that young adults — the most prized of all enrollees — are a disproportionately large segment among the deadbeats. Which means the looming adverse selection problem is about to get worse, not better.

While we focus on the travails of the federal Healthcare.gov exchange for ObamaCare, don’t forget that the state exchanges aren’t necessarily faring much better. As the White House hailed new enrollment numbers that looked less than hailable on closer examination, the nation’s most populous state decided to shut down a key component of their own system. Covered California’s small-business exchange, SHOP Marketplace, will remain closed for months:

The nation’s most populous state has elected to temporarily shutter its new online health insurance marketplace for small business only four months after it launched, dealing yet another blow to a key element of the health care law meant to lower costs for employers.

California officials on Wednesday announced they are suspending online enrollment effective immediately for small businesses on the state’s new health insurance portal, known as Covered California. Health plans available through the state’s Small Business Health Options Program (or SHOP) will still be available but can only be purchased over the phone, via paper applications or through insurance agents.

State health officials say they will use the time to “implement a series of redesigns.”

“The SHOP portal was not meeting the needs of agents or small employers and needed improvements,” Covered California Executive Director Peter V. Lee said in a statement announcing the decision. “Taking the portal offline will not affect the paper application process, which has been the preferred enrollment method traditionally used by insurance agents in the small-group market.”
The state has not made a decision whether to retain the company responsible for the web-site failure as yet. Care to guess what company that turns out to be? No, it’s not CGI Federal, who recently got fired by HHS for its Healthcare.gov woes. Instead, it turns out to be … the same company that got the replacement contract on a no-bid basis:

Accenture is the lead contractor on Covered California’s SHOP program. Hicks said it remains to be seen if the company will be retained.

Accenture officials had yet to respond to requests for comments. There are no reports of similar issues with other states’ SHOP portals.
Yes, Accenture turns out to be just as incompetent as CGI Federal, even on the smaller scale of the SHOP Marketplace portal, which served small businesses of under 50 employees voluntarily looking for health insurance coverage for their workers. Changing from CGI Federal to Accenture might not be much of a difference in competence — and not much of a difference in personnel, either. I linked this NYT report earlier in the week, but it’s worth a second look in this context:

After denigrating the work of CGI and replacing it as the largest contractor on the federal health care website, the Obama administration is negotiating with the company to extend its work on the project for a few months.

And the new prime contractor, Accenture, is trying to recruit and hire CGI employees to work under its supervision. …

The government altered the proposed contract over the weekend, the person said, to identify specific CGI employees whom federal officials wanted to retain.

“This appears to be a typical government contract shuffle,” Luke Chung, the president of FMS, a software development company in Vienna, Va., said of the handoff. “A new company wins the contract and hires many of the old people. It happens all the time in government.”
That’s true, but usually it happens when the government wants to retain competency and continuity on successful programs. In this case, neither company has proven competent at its work in this field on large or small scales. Don’t expect anything to improve while HHS merely shuffles letterheads while keeping the same people who produced failure after failure on the job.

Video: What happened to the Cover Oregon audit?

POSTED AT 10:01 AM ON FEBRUARY 14, 2014 BY ED MORRISSEY

How did Cover Oregon blow through more than $120 million and end up with a completely non-functional website? One year ago, when Oregon officials raised questions about the project and the contracts going to Oracle, Oregon Health Authority CIO told other state officials in a Cover Oregon meeting that the Secretary of State’s office had conducted an audit of the contracts, and found no problem. A year later, no one can find any evidence of that audit, which adds yet another dimension to the allegations of fraud involving Carolyn Lawson and Cover Oregon. KATU continues its in-depth investigation of the scandal:

The report goes on to say the issue was resolved, citing an audit by the Secretary of State’s office that “found everything in order.”

But the KATU On Your Side Investigators have learned that that audit – the only piece of evidence used to dismiss major accountability problems surrounding a contract that eventually grew to $119 million – doesn’t exist.

That audit was particularly important because the state’s contract with Oracle lacked the safeguards government’s usually put in place to ensure transparency. ….

“I checked with our managers and there is no audit that would substantiate the statement that ‘a SOS audit found everything in order,’” Secretary of State auditor Gary Blackmer wrote to KATU News. “We have not conducted any audits of procurement or accounting practices related to the DHS/OHA Oracle contract.”

The video gives a pretty good overview, but you’ll want to read the full article as well. The QA group Maximus did its own audit, which found exactly the opposite of what Lawson told the rest of the team in that meeting. The problem was that the contracts essentially amounted to “blank checks” because the Cover Oregon team had little documentation about what Oracle was being contracted to produce, and what was provided (Statements of Work, or SOWs) were entirely inadequate. In addition, Maximus found that Oracle used the funds to perform work “outside the scope of the HIX-IT project” — or in other words, it used Cover Oregon money to do other work.

It’s not as if this problem was unnoticed. In that February 2013 meeting, the other Cover Oregon players clearly had concerns about this issue. Lawson put them off by making her claim about the SoS audit, but not everyone was buying it. It also raises the question — again— of what Governor John Kitzhaber knew about the failures of this project and when he knew it. Lawson ended up in tears during the meeting, according to KATU, and at least one of the attendees presumably had a reporting relationship to Kitzhaber (interim state CIO Julie Pearson). It’s difficult to believe that concerns of that depth and at that level eight months before the rollout deadline wouldn’t have reached Kitzhaber’s desk at that time, let alone down the line when the project was clearly derailing.

Don’t be surprised to see fraud investigations at a couple of levels resulting from this scandal.

2/13/14.....

CBS: Insurers less optimistic than WH on ObamaCare “enrollment” numbers

POSTED AT 2:01 PM ON FEBRUARY 13, 2014 BY ED MORRISSEY

The White House jumped at the latest “enrollment” figures from the ObamaCare program as proof that the program had turned the corner, and supporters followed suit. Less enthused were those who actually sell the product through the Healthcare.gov exchange. CBS News’ Sharyl Attkisson reports today that insurers are treating the figures with considerable skepticism — even if the numbers turn out to be accurate:

But the rosy portrait shatters under an alternate interpretation by insurance industry representative Robert Laszewski of Health Policy and Strategy Associates.

“They made a big deal about the age results,” said Laszewski after reviewing the HHS numbers. “But the greater challenge for them is the low number of people enrolling. There is no way you can get a good spread of risk with such a small percentage of the total eligible signing up.”

CBS News also received a guarded analysis from a source involved in implementation of the Affordable Care Act who supports Obamacare.

The source said the bump of young invincibles to 27 percent of January enrollees was “progress,” but added “they neglect to point out that they need roughly 40 percent to help achieve a balanced risk pool” necessary under a successful business model.

“3.3 million people is still a relatively small proportion of the population that ‘should be’ interested,” added the source, who is not authorized to speak on behalf of the administration and does not wish to be identified.

Yet this underestimates the true extent of enrollment dropoffs. The HHS reporting period for December was four weeks, beginning on 12/1 and ending on 12/28. The reporting period for January was five weeks, beginning on 12/29 and ending on 2/1. This suggests that in December, enrollments averaged 447,000 per week, compared to 229,000 in January, or a 49 percent drop-off in new enrollees.

It is clear by now that the administration will not reach the original CBO estimate of 7 million enrollees by the deadline at the end of March. The real question is: how far short will they fall? If February’s enrollment rate matches that of January, the Administration will be able to claim 916,000 more enrollees in the current reporting period, for a grand total of about 4.2 million. That is 60% of the initial CBO estimate with a month to go before the end of open enrollment. On the other hand, it is hard to tell whether matching the pace set in January is reasonable for February. Notably, Kathleen Sebelius announced on January 24 that HHS had reached 800,000 enrollees already for the month, suggesting that the rate in the final two weeks of the month was lower than the rate in the first three weeks.

I’m not convinced that the rate will remain steady. The imperative of signing up in December was obvious — millions of people got kicked out of their insurance plans by the end of the year and had to replace them. Most of that demand would have been resolved by now, which means that (a) a significant number of those booted out simply decided not to buy insurance again, and (b) what’s left to enroll will be the population of the willingly uninsured. By now, that population would have already made their decision about whether or not to remain uninsured, pay the relatively small fine, and wait until a big health issue popped up. At that point, insurers would have to cover them anyway, so why would healthy people pay premiums on plans with large deductibles that won’t benefit them in any way?

Don’t be surprised, then, to see momentum slow even further, and put the Obama administration and insurers in a very bad position regarding 2015 premiums.

By the way, Obama almost certainly lied when he said no one told him about Healthcare.gov’s problems

POSTED AT 6:01 PM ON FEBRUARY 13, 2014 BY ALLAHPUNDIT

We all already assumed that, I know. No matter how desperately The One may want to save face by refusing to fire Sebelius, there’s no way he would have kept her on if she had ruthlessly hidden the site’s problems from him until it went live and embarrassed him in front of the world. Of course he knew. And really, what incentive did Sebelius have to hide the truth? Even if she thought very early on that HHS could pull it together at the last minute and get the site ready by October 1, it must have been apparent soon enough that that was impossible. At that point, she had nothing to lose by telling O and everything to gain — i.e. keeping her job — by being honest.

While Sebelius has said the president was not aware of HealthCare.gov’s problems, more than 750 pages of documents obtained by The Hill through a Freedom of Information Act request show she made scores of visits to the White House.

The documents reveal that Sebelius met with or attended calls and events with Obama at least 18 times between Oct. 27, 2012, and Oct. 6, 2013, including at least seven instances in which the two were scheduled to discuss the new healthcare law, according to the secretary’s draft schedules.

She had breakfast or lunch with Pete Rouse, considered one of Obama’s closest advisers, at least three times. Moreover, Sebelius had scheduled calls or meetings with Valerie Jarrett, an Obama confidante, and White House chief of staff Denis McDonough…

The schedules suggest Sebelius was an active White House presence in the months leading up to the botched rollout, and raise new questions about why Obama wouldn’t have known about the problems that were exposed on Oct. 1.

If we’re ranking the biggest ObamaCare lies told by Obama, this probably doesn’t crack the top ten. Even so, I’m curious: Why weren’t these many meetings on the president’s official calendar? When Peter Schweizer pored over O’s public daily comings and goings from 2010 onward, he found dozens of meetings with other cabinet members but just a single solitary huddle with Sebelius. How come? When Schweizer first published that, it made Obama look like he was criminally disengaged from the ObamaCare rollout. According to what The Hill found, though, he wasn’t disengaged; he was, it seems, fully up to speed on the problems before launch day, then merrily lied about it once reporters started asking questions later.

Speaking of ObamaCare and lies, a friend sends along a good question in response to yesterday’s post about the somewhat dubious numbers for January. All along, the law’s defenders have insisted that HHS is missing its enrollment targets chiefly, or even exclusively, because of the botched website launch in October and November. (They hit their target in January — assuming you include people with unpaid premiums in the final numbers — but they’re still a million enrollees short of where they hoped to be right now overall.) I’m embarrassed to say I’ve accepted that logic myself before. Practically no one signed up in Healthcare.gov’s first two months so that must be why they’re still so far behind. But … does that make any sense? Even if you spent a week or two trying to sign up in October and then threw your computer out the window in frustration, you must have heard by now that the site’s working better and that the number of sign-ups have soared. This idea of a million people being “missing” from the enrollment ranks assumes that the people who were thwarted early on have all given up irretrievably. Why would they do that?

My friend’s theory is that this has little to do with computer glitches and a lot to do with rate shock. It doesn’t make sense that, having once failed to enroll, people would stop trying forever. It does make sense that, having finally seen what they’ll be paying in premiums, they’ve made a reasoned decision to pass. That seems plausible to me, especially since the risk pools right now are conspicuously short of younger adults. It’s the “young healthies” who are in the best position to pay the mandate penalty this year and risk going without coverage. Maybe that’s the missing million, not the victims of October’s 404pocalypse.

The incremental nature of change makes it difficult for us to notice how systems that once worked well with modest costs have transmogrified into broken systems that cost a fortune. Exhibit # 1 is higher education: 40 years ago, four-year public universities were affordable and two-year community colleges were almost free. Now students have to borrow $1 trillion to pay for the exorbitant privilege of higher education.

And no, the difference isn't that states don't provide the same funding--the difference is costs have soared while the yield on the investment has plummeted. Please read:

Longtime correspondent Ishabaka (an M.D. with 30+ years experience in primary care and as an emergency room physician) responded to this article with an insider's account of what happens when greed and cartels take over healthcare. After readingWhat's wrong with American hospitals?, a scathing deconstruction of for-profit healthcare, Ishabaka submitted this commentary:

I could have told you what was wrong with our hospital system by 1989 - nobody would listen to me back then.

Up til the '70's, almost all hospitals in the United States were not for profit COMMUNITY HOSPITALS. They were LOCAL. The Board of Directors was made up of some senior doctors, maybe the head nurse, and various other prominent local businessmen and professionals. Others (mostly Catholic), were run as non-profits by religious orders. A very few, mostly very small hospitals were for profit, usually owned by a group of doctors, or even one doctor.

The mission of these community hospitals was to provide for the LOCAL COMMUNITY - one and all. Payment was various - private insurance, Medicare, Medicaid, self pay - and the idea was to collect just enough money to keep the hospital going, and provide care for the poor who had no money to pay. If your grandma got bad care - you could go - in person - to the local, say, banker, on the Board of Directors, and tell him - and he would CARE.

THIS SYSTEM WORKED, and kept costs DOWN. Remember, the hospital just needed enough money to stay in the black. Often local wealthy people would will money to the hospital in which they had been cared for.

In the '80's - there was the arrival of the for-profit cartels - and I use the world cartels specifically - these were run by people with the sociopathic Goldman Sachs type mentality - their sole goal was to acquire huge sums of money for themselves, their hospital directors, and their SHAREHOLDERS. They used a typical sneaky technique - they'd come into town, and tell the locals they could run the hospital much cheaper, because of their economy of scale. People believed this, and the cartels bought out most of the community hospitals.

I worked at one such for-profit hospital and had a 21-year old indigent man come in who'd been struck by a car while walking, and was rapidly bleeding to death. The hospital administrator refused to open the operating room, even though I had a surgeon right there, willing and able to operate for free to save this young man's life. The surgeon threw a fit, and he was a big wheel at the hospital and the administrator backed down - otherwise I firmly believe the young man would have died. This was LEGAL back then, before the EMTLA law was passed because similar abuses were rampant NATIONWIDE.

Around this time, the administrators of the remaining community hospitals found out the administrators of the for-profit hospitals were making tens of times their salaries - and bonuses based on profits - and started demanding similar salaries and bonuses based on PROFITS - a contradiction of the old concept of community hospitals (the article does touch on this).

How do you increase hospital profits? Number one - avoid any care for the poor you can weasel out of. Number two - cut staff to the bone and beyond (one of hospital's biggest expenses). Most American hospitals now have UNSAFE nurse to patient ratios because of this.

As far as patient care goes, nurses are the most important people in hospitals. I know of one lady who DIED while in a monitored bed, and wasn't found dead until several hours later due to the criminally low nursing staff ratio in a hospital I worked in. I HAD complained about the dearth of nurses, and was threatened with the loss of my job. Another side effect of this is, nursing in hospitals has become unbearable for nurses who really cared about their patients - many good hospital nurses have left hospital work for other fields. The results are appalling.

I saved the life of a patient an unqualified, under-educated nurse gave the wrong medicine to - a medicine that IMMEDIATELY MAKES YOU STOP BREATHING, because it was cheaper for the hospital to hire her than a knowledgeable and experienced nurse. The medicine is pancuronium bromide, if you want to Google it. The nurse didn't know one of the effects was cessation of breathing - this is Pharmacology for Nurses 101, this drug is used all day long in every operating room in America (where doctors WANT patients under anesthesia to stop breathing, and put them on breathing machines during the surgery - which is very safe if done correctly).

I could go on and on. Simple things, like the instruments you use to suture cuts - community hospitals used to buy Swiss or German made ones that were of the finest quality, sterilize and re-use them over and over. This changed to disposable instruments that sometimes literally fell apart in my hands. Bandage tape that didn't stick, instead of quality Johnson and Johnson tape - anything to save a buck.

It is not getting better, it is getting worse. The nurses I know tell me hospitals are cutting staff even MORE now in preparation for Obamacare.

I will end with a story that illustrates the difference between Old School and New School hospital administrators.

I had the pleasure of working five years in a real community hospital. One of the senior administrators (R.I.P.) was a gentleman who'd made his fortune in the grocery business. In his late 80's, he would arrive at the emergency department entrance every morning between seven and eight am, and proceed to walk throughout the hospital. He would ask various and sundry staff how they were getting along - everyone from janitors to senior physicians. If something was amiss - HE RECTIFIED THE SITUATION. Tragically, this hospital was bought out, and is now part of a chain.

I had the displeasure of working in a "community" (really for-profit) hospital with a middle aged administrator who NEVER set foot outside his office or conference rooms - he NEVER appeared in the (very large and busy) emergency department once. This was in the early 90's, and one year it was revealed that his compensation was $600,000 - and a brand new Lexus as a "performance bonus". He was on the golf course by three pm every single day. That was the hospital where the woman who was being "monitored" (alarms and all that) was found very cold and dead after a delay of who knows how many hours.

Thank you, Ishabaka, for telling it like it really is. Needless to say, ObamaCare (the Orwellian-named Affordable Care Act--ACA) purposefully ignores everything that is fundamentally broken with U.S. sickcare and extends the soaring-cost cartel system, essentially promising to stripmine the taxpayers of however many trillions of dollars are needed to generate outsized profits for the cartels.

Only those with no exposure to the real costs of ObamaCare approve of the current sickcare system. Government employees who have no idea how much their coverage costs, well-paid shills and toadies like Paul Krugman, academics with tenure and lifetime healthcare coverage--all these people swallow the fraud whole and declare it delicious.

Only those of us who are paying the real, unsubsidized cost know how unsustainable the system is, and only those inside the machine know how broken it is at every level. Greed + cartels = Sickcare/ObamaCare. Love your servitude, baby--it's affordable, really, really, really it is.

Minnesota's exchange enrollment goal of 67,000 seemed within reach on Jan. 4, when signups stood at 25,860.
But after surging by more than 4,000 per week in the prior five weeks, signups collapsed back to November's pace of less than 700 per week.

It gets worse:

Further, a spotty payment rate (50% in Washington and 66% in Nevada) creates a risk that the demographics of the paid exchange population may be older — and possibly sicker — than even the national signup data have signaled.

Not only are they not signing up they're not paying either.

What's worse is that Minnesota has data on the plan split information and it suggests that the people signing up are all HIV sufferers and similar. Only 21% of the signups are in the key 18-34 demographic that have to sign up en-masse for the numbers to work. What's even worse is that nearly 30% of the people signing up have taken "platinum" plans that pay for almost everything -- a financially-suicidal option unless you know you're going to hammer the system with extremely high costs.Where's the media coverage of this debacle and its depth? Missing. Gee, I wonder why when the first two purchases for a newly-hired "reporter" in the mainstream media are a set of kneepads and a dental dam.

Obamacare Enrollment Hits 3.3 Million (but not really)

HHS announced Wednesday that a cumulative total of 3.3 million people have now signed up for private insurance through the Obamacare exchanges but that figure includes hundreds of thousands of individuals who have failed to make their first premium payment.

Three weeks ago Breitbart News looked at a mid-January announcement by HHS that enrollment had surpassed 3 million and estimated what that meant for theentire month:

Since December 28th enrollment is up about 850,000. If we assume the three million milestone happened mid-week then the total at the end of January should be in the neighborhood of 1.1 million.

The actual January enrollment announced today was 1,146,000.

The administration continues to say it cannot estimate how many people who have selected plans have actually paid a first month's premium since the payment system has not been built. Experts and journalists who have spoken to insurers say the total percentage who have not paid is around 20 percent. This means it's possible HHS is now double counting some people who were dropped after failing to meet a mid-January deadline but are now applying again.

HHS also highlighted the fact that the percentage of young people 18-34 enrolling was 27 percent in January compared to just 24 percent in October through December. That's an improvement obviously but it's not nearly enough to bring Obamacare to the overall 38 percent level that was anticipated prior to launch. Once the new figures are averaged in with the rest, we can see how little difference they make. The cumulative percentage of young people for all four months of enrollment now stands at 25 percent, an increase of just one percent from where it stood at the end of December.

The graph at the top of this post (produced by the American Action Forum) shows how Obamacare enrollment (the gold line) is going compared to HHS' goal (the green line) and Medicare part D (the red line). As you can see, overall enrollment is more than a million short of expectations (and that's including hundreds of thousands of people who are not actually enrolled). It's going to take a huge surge in March like the one we saw in December for the program to meet its reduced CBO estimate of 6 million.

POSTED AT 12:01 PM ON FEBRUARY 13, 2014 BY ED MORRISSEY

Obama’s central command policies are inevitably crashing into each other. The waiver may provide some relief to endangered Democrats, but it also gives employers an incentive to lay off employees in order to get under 100 and qualify for the illegal waiver. So Obama has unilaterally legislated illegal conditions on the illegal waiver. To wit, employers will be required to certify to the IRS,under penalty of perjury, that the waiver was not a motivating factor in the company’s hiring and firing decisions. As Fox News’s Chris Stirewalt quips, “To avoidObamaCare costs you must swear that you are not trying to avoid ObamaCarecosts.”

So now Obama, like a standard-issue leftist dictator, is complementing lawlessness with socialist irrationality.

Think about how lunatic this is. There is nothing even faintly illegal about businesses’ – indeed, all economic actors’ – making financial decisions based on tax consequences. (And remember, notwithstanding Obama’s misrepresentations to the contrary, Obamacare mandates are taxes – as Obama’s Justice Department argued and as Chief Justice Roberts & Co. concluded.) The tax consequences of Obamacare are profound – that is precisely the reason that Obama is “waiving” them. No responsible officers in a corporation of relevant size would fail to take them into account in making the decision to staff at over or under 100 employees; in determining whether some full-time employees should be terminated or shifted to part-time; or in making any number of the decisions Obamacare’s mind-numbing complexity requires.

The officers’ responsibility is to the owners of the company, the shareholders. The business exists to create value, not to provide employment – employing workers is a function of the value added to the enterprise, not the need to create a more favorable election environment for the statist political party. Corporate officers who overlooked material tax consequences would be unfit to be corporate officers.

What is illegal and irrational is not a company’s commonsense deliberation over its costs, it is Obama’s edict. And look what attends this one: criminal prosecution if Obama’s Justice Department decides the business has falsely certified that its staffing decision was not motivated by Obamacare.

The Obama administration declined to specify exactly why this warning went out in the first place. It became necessary because employers have discovered just how much cost Obamacare will add to their ledgers. Democrats who pushed the employer mandate insisted at the time that businesses would find that the law bent the cost curve downward and would welcome its impact.

Instead, skyrocketing premiums and taxes have created a big jump in personnel costs (AOL CEO Tim Armstrong estimated it at $7 million annually), which employers will have to resolve either through staffing reductions, downward adjustments in compensation, or higher prices.

Small wonder, then, that the White House pushed the mandate enforcement deadline out even further for mid-sized employers. President Obama himself said that he wanted to keep businesses from dealing with the real-world consequences of the law. “Even with the tax credits,” Obama told reporters in a press conference, “in some cases they still can’t afford it, and we have hardship exemptions, phase-ins, to make sure that nobody is unnecessarily burdened.” …

Furthermore, the sudden demand that businesses stop adjusting for regulatory policy is nearly the height of hypocrisy for this administration, which has repeatedly offered short-term gimmicky tax credits for business decisions that boost its policies, including an ill-considered credit for hiring that ended up costing taxpayers millions for hiring decisions that would have been made anyway. Suddenly, the Obama administration has to take action outside of the law because employers respond to regulatory signals more predictably than one-off credits.

In other words, it’s a demonstration of arbitrary power, of precisely the kind predicted by Hayek. And it’s no longer just opponents of the ACA noticing.

The specific regulation is on page 124 of this PDF from the Federal Register. It stipulates that the full exemption for the mandate applies if “the employer does not reduce the size of its workforce or the overall hours of service of its employees in order to satisfy the workforce size condition”–that is, if it doesn’t fire workers to get below 100:

A reduction in workforce size or overall hours of service for bona fide business reasons will not be considered to have been made in order to satisfy the workforce size condition. For example, reductions of workforce size or overall hours of service because of business activity such as the sale of a division, changes in the economic marketplace in which the employer operates, terminations of employment for poor performance, or other similar changes unrelated to eligibility for the transition relief provided in this section XV.D.6 are for bona fide business reasons and will not affect eligibility for that transition relief.Legal or regulatory changes that affect the cost of labor would fall into the category of “changes in the economic marketplace in which the employer operates.” So it would be more precise to say that employers may cut back employment for any bona fide business reason except to take advantage of the ObamaCare mandate delay.

The administration thus acknowledges that its policy creates a perverse incentive and orders employers not to act upon it. But that can’t be enforced. A business will take into account all relevant factors, including the additional costs imposed by ObamaCare, in making decisions about hiring and firing, including whether to terminate employees for poor performance, sell a division, etc. In practice, the new rule is a ban–under threat of criminal liability–on acknowledging the perverse incentive. Call it OmertàCare, a government-imposed conspiracy of silence.

In other words, the legal justification for this “self-attestation” springs from an illegal action by the Obama administration, as a means to include the company in the increasingly-arbitrary application of regulation based on ignoring the statutes of the law itself. It’s lawless lunacy, certainly. But as I argued in my column, that’s precisely the outcome predicted by Hayek in The Road to Serfdom.

The law clearly states that the employer mandate was to take effect at the beginning of 2014. The administration delayed it for a year because of thenegative headlines. Now, with Democrats’ control of the Senate on the line, the administration delayed it again.

Not only does the law say that the employer mandate was supposed to take effect, there is absolutely no authority anywhere in its text to require an employer to meet this completely arbitrary criteria.

So rather than be honest about the effect that the mandate is having on employers and their workers, the administration wants to put business owners in the tough position of doing something they financially may not be able to afford or lie to a powerful federal agency. That makes no sense at all.

Just like OmertàCare.

2/12/14......

HHS: 3.3 million people have now signed up for ObamaCare — but we won’t tell you how many actually paid

POSTED AT 4:41 PM ON FEBRUARY 12, 2014 BY ALLAHPUNDIT

The latest enrollment data from the Obama administration show that 3.3 million people have signed up for private health insurance through federal and state insurance exchanges created under the Affordable Care Act. This figure represents all enrollment from Oct. 1 through Feb. 1. It includes both people who have and have not paid their first month’s premium. Of those people, 1,146,100 selected their health insurance plans in January, meaning there was a 53 percent increase enrollment last month alone.

This makes January the first month that the Obama administration has beaten an enrollment target. Back in September, way before HealthCare.gov’s botched launch, the Centers for Medicare and Medicaid Services projected that 1,059,900 people would sign up for private health insurance in January.

That’s the good news for HHS. Despite anecdotal evidence from some of the state exchanges that enrollment had leveled off in January after the big December pre-deadline surge, federal sign-ups are still sufficiently robust to beat a monthly projection. Which is not to say they’re on target to hit their overall sign-up goal for the first year: They’re still more than a million enrollees shy of where they hoped to be right now thanks to the Healthcare.gov Chernobyl in October and November.

Now, big question. How many of those 3.3 million are paid up and how many are soon to be kicked off the rolls by their insurers because they never ponied up for their first month’s premium? HHS is … less interested in that number.

Five days ago, Bob Laszewski phoned around to insurers and was told that, on average, about 20 percent of new enrollees in each plan have yet to pay their premiums. Apply that to HHS’s figures and they’re overstating sign-ups by more than 600,000 people. Worse, Laszewski says that nonpayment rates tend to be higher for larger insurers than for smaller ones, presumably because the latter have less of a bureaucratic nightmare to sort through after the December enrollment rush and were able to reach out to deadbeats before the payment deadline. If that’s true, the number of soon-to-be canceled enrollments may be even higher. HHS wants you to take away from today’s topline enrollment figure that they made it three-quarters of the way to their target for January 31st despite the horrendous first two months, but depending upon how bad the nonpayment numbers are, they may be closer to one-half of the way there.

Two more footnotes that HHS doesn’t want you to notice. One: The number of young adults who signed up last month was slightly higher than in the months before, which is good news for ObamaCare’s risk pools. The more “young healthies” there are forking over premiums for coverage they don’t really need, the more revenue insurers have to subsidize the old and sick. Even though the percentage is up, though, it’s still not close to where it needs to be. Right now young people make up roughly 25 percent of risk pools; HHS’s target for that group in order to produce sustainable pools by the sign-up deadline on March 31 was 40 percent. They’ll need massive numbers of “young healthies” to bite the bullet over the next seven weeks to make that happen. The deadline next month will probably generate another last-minute enrollment spike, but it’ll have to be enormous to move the dial. See now why they’re doingYouth Enrollment Day? They’ve got an adverse selection problem and not much time to solve it.

About four-fifths of those choosing health plans to date qualified for financial assistance to help pay their premiums, administration officials said.

Fully 80 percent of sign-ups so far are being subsidized. I say it “seems” like a lot because I looked around for an HHS baseline projection to compare it to and couldn’t find one. If it’s out there, please send it along and I’ll update. A Twitter buddy sent me this piece from November quoting a Kaiser Family Foundation specialist as predicting that only 60 percent or so of enrollees would qualify for financial assistance. Could be that Uncle Sam’s on the hook now for more sugar than he expected, although it stands to reason that people who need subsidies might sign up earlier than people who don’t. If that’s so, then that 80 percent figure will plummet over the next seven weeks as more middle class people finally get around to enrolling. If it isn’t, ObamaCare’s going to end up being even more expensive than we thought.

As for how many enrollees were previously uninsured and how many had coverage before their plans were canceled by ObamaCare, HHS is playing that one close to the vest too. Go figure that if you strip a few million people of insurance, a few million people might sign up for a new insurance product they’re legally required to buy anyway.

Update: Via John Merline and Morgen Richmond, here’s the answer to the subsidies question: CBO estimated that five of every six O-Care enrollees, or 83 percent, would qualify for some sort of subsidy. Today’s four-fifths numbers is right in line with that. See the table below, with markings from Morgen.

In other news, CBO projects that fully 83 percent of ObamaCare consumers will be getting taxpayer money. Sheesh. A good point from Morgen, though: “I’m a little surprised – and skeptical – about the reported numbers because I thought a pretty substantial number of the enrollees were those who had lost existing coverage…and likely to be at an income range where they would not be eligible for a subsidy.”

How many ObamaCare enrollees have paid for coverage?

POSTED AT 3:21 PM ON FEBRUARY 12, 2014 BY ED MORRISSEY

The White House and its supporters have begun bragging that the ObamaCare system has started to function as planned, with sign-ups increasing as the deadlines approach for the individual mandate deadline. But how many of those sign-ups turned into actual enrollments through the payment of the premium? As it turns out, not nearly as many as the top-line numbers suggest:

While the number of states reporting this information is small, they actually make up a good chunk of Obamacare’s currently accepted 3 million nationwide enrollment total. According to the Obama administration’s most recent detailed report on enrollment data, these five states — New York, California, Washington state, Nevada and Rhode Island — account for a third.

California’s exchange last reported that three-fourths of its reported enrollees had paid their first premiums, according to California Healthline; Washington’s totals released Tuesday indicate that only 51 percent have purchased their plans.

New York’s numbers are fuzzier, since the exchange itself doesn’t separate applications for Medicaid and private plans. It counts 412,221 enrollments for public and private coverage (just 251,000 are private plans), but notes that another 697,000 customers have completed applications on the exchange website. If the entire 421,221 have paid (or accepted the low- to no-cost Medicaid coverage), New York’s payment rate is only 59 percent.

Nevada’s payment rate is just 66 percent — 14,999 out of 22,597 so far — and Rhode Island has by far the best total, with 14,086 paid customers out of 16,512, for a payment rate of 85 percent.

Those numbers aren’t much improved from a month ago, when industry expert Bob Laszewski estimated the payment figure at 50%. The federal system’s back end for dealing with those issues is stillmissing in action, too, which means it’s going to be even more problematic. We’re about a month out from the big deadline for the April 1 cutoff for enforcement, and at the very best, we can say that the signup-to-paid ratio isn’t improving by much, if at all.

That may be a surprise to Laszewski, who predicted an 80% clearance rate by this time, which only Rhode Island appears to be achieving. He also noted a multitude of issues in the federal system still awaiting resolution:

Last fall I said that I thought it would be late January or early February before Healthcare.gov would generally be fixed.

Boy, was I wrong.

The to-do list still includes:

Problems with the government sending enrollment transactions to the carriers––the 834s––that are still having error rates much too high for high volume processing.

The inability of the government to do an automated enrollment reconciliation with the carriers––to be able to sort out who really is covered and who is not––because that system still hasn’t been built.

The inability of the government to pay carriers because that system hasn’t been built––carriers are sending estimated bills to the feds.

The inability of the government to add and delete people from the system for things like a newborn or a divorce because that system hasn’t been built yet.

The inability of the government to handle appeals when people think their eligibility or subsidy calculation is wrong because that system hasn’t been built yet.

The inability of the government to cancel people off of Healthcare.gov because they never built that functionality. As a result, I expect they will be reporting bloated enrollment numbers for some time.

At least two carriers have told me that because the government can’t cancel people off the system, it the person shows up next month they can’t reenroll on Healthcare.gov because the government can’t get the old enrollment off the system.

What kind of progress is being made in Minnesota, where the MNSure administrator ended up getting fired over its launch failures? Investors Business Daily offers a look, and it’s not pretty:

But after surging by more than 4,000 per week in the prior five weeks, signups collapsed back to November’s pace of less than 700 per week. …

Only 21% of signups were in the key 18-34 demographic vs. 35% ages 55 to 64. Minnesota officials have been taken by surprise at the share of people signing up for ObamaCare’s richest “platinum” coverage, which reimburses 90% of the covered group’s qualifying expenses.

Fully 29% have signed up for low-deductible platinum policies — compared to a projection of 5%. Such policies would tend to be favored by people who want to guard against high medical expenses, while someone expecting minimal costs might go for a high-deductible bronze plan.

Enrollment is currently at 92,000, which is still way short of their goals by for enrollment prior to March 31. The worry is if they don’t have enough people paying into MNsure, it won’t be sustainable and they’ll have to ask the legislature for more money.

Minnesota lawmakers have warned leaders of MNsure that they must figure out budget needs soon as insurance enrollment trends point to a 2015 deficit. MNsure must give lawmakers a proposed 2015 budget by March 15.

The 92,000 figure includes the Medicaid enrollments through the system, too. The problem is in the lack of private-insurance enrollments, and it’s going to be a huge problem for the state legislature, which is already strapped for funds as it is.

This portends two separate risk pool problems. First, not enough young and healthy people are signing up — a trend that has been well established for some time. Minnesota’s 21 percent figure is nearly identical to what health insurer Humana is reporting in its nationwide risk pool so far — and roughly half of the administration’s initial goal within this demographic. Second, a surprisingly high number of enrollees are selecting “platinum” plans, indicating that they anticipate incurring high levels of annual medical expenses and are looking to minimize out-of-pocket costs. Add these two together, and you’re staring at an adverse selection problem, which may result in larger taxpayer bailouts of on-the-hook insurers.

Also take note of the paltry payment rate of “enrollees” in Washington State so far … Washington has a payment rate of just 50 percent, with Nevada sitting at 66 percent. Both states are far off pace to hit their 2014 targets, even counting unpaid “enrollments.”

Boehner’s Office on Obama ‘Rewriting’ ACA: ‘We Are Examining All of Our Options’

House Majority Leader Eric Cantor and House Speaker John Boehner (AP Photo/Jacquelyn Martin)

(CNSNews.com) - House Speaker John Boehner’s office said today that he is examining options on how to respond to what the speaker yesterday characterized as President Barack Obama’s “rewriting” of the Patient Protection and Affordable Care Act “on a whim.”

On Monday, the Treasury Department announced a new regulation that frees employers with between 50 and 99 employees from complying until 2016 with the Affordable Care Act mandate that requires all employees with at least 50 full-time workers to buy them health insurance.

Under the law, such employers were required to comply with the insurance mandate by Jan. 1, 2014--or pay a fine to the federal government.

The administration's new regulation also changed the nature of the mandate for employers with 100 or more employees, stating that they would only need to insure 70 percent of their workforce in 2015 to escape a penalty.

The new regulation directly violates the plain language of the Affordable Care Act. The act says “an employer who employed an average of at least 50 full-time employees on business days during the preceding calendar year” must purchase “minimum essential coverage” for those employees.

In imposing a statutory deadline for doing so, the law says: “EFFECTIVE DATE.—The amendments made by this section shall apply to months beginning after December 31, 2013.”

On July 2, 2013, Obama unilaterally moved the deadline for the employer mandate from the beginning of 2014 to the beginning of 2015. He did so without asking Congress to change the law--and in direct contradiction to the law itself. On Monday, Obama again unilaterally moved the deadline for the employer mandate, this time pushing it back to the beginning of 2016 for businesses with between 50 and 99 full-time employees, and saying that employers with more than 99 employees need only insure 70 percent of their workforce.

“Once again, the president is giving a break to corporations while individuals and families are still stuck under the mandates of his health care law. And, once again, the president is rewriting law on a whim,” Boehner said in a statement released Monday in response to the new regulation.

“This continued manipulation by the president breeds confusion and erodes Americans confidence in him and his health care law,” said Boehner.

At a press briefing by the House Republican leadership on Tuesday, Boehner said that the House would be taking up a bill to increase the debt limit that would not include any countervailing provisions, such as cuts in spending. Boehner said this increase in the debt limit would be passed with the votes of the House Democrats and a “minimum number” of Republicans, including himself.

Later on Tuesday, CNSNews.com asked Boehner’s spokesman Michael Steel two questions in light of the Boehner’s statement that Obama, in unilaterally changing the Affordable Care Act, was “rewriting law on whim.”

CNSNews.com asked: "1) Does Speaker Boehner intend to lead the House of Representatives in using its constitutional powers to in any way to counter or reverse the president’s unilateral “rewriting” of the Affordable Care Act?” 2) If Speaker Boehner intends to the lead the House in such an action, what will that action be?"

“We are examining all of our options,” Boehner’s spokesman Steel said in response. He could not say when the speaker’s office would be able to announce what action it had decided to take.

Treasury: Employers must “self-attest” that ObamaCare not behind staffing decisions – under penalty of perjury

The latest announcement comes after the administration heard from businesses about their concerns with the looming ObamaCare rules. However, the change is sure to raise more questions about the health and implementation of the law. Fewer workers getting insurance through their employers could mean more individuals on the ObamaCare exchanges seeking subsidized coverage, increasing the cost to taxpayers.

Some lawmakers, though, have claimed that the mere threat of the employer mandate is causing companies to shed full-time workers in the hope of keeping their staff size below 50 and avoiding the requirement.

Administration officials dispute that this is happening on any large scale. Further, Treasury officials said Monday that businesses will be told to “certify” that they are not shedding full-time workers simply to avoid the mandate. Officials said employers will be told to sign a “self-attestation” on their tax forms affirming this, under penalty of perjury.

Officials stressed that the latest reprieve applies to a relatively small percentage of employers — albeit companies that employ millions of workers.

Er … exactly what gives Treasury the authority to demand that kind of pledge, anyway? The law only mandates that employers provide coverage for full-time employees, a status defined by working 30 or more hours a week. It doesn’t contain any authority for Treasury or anyone else to force current full-time employees to stay in that status, nor for the federal government to dictate ratios of full-time/part-time staff.

The Obama administration is big on self-attestation, huh? Just ask the Little Sisters of the Poor. They’ve certainly gotten the “bully” part of the bully pulpit in mind these days at the White House.

This seems an opportune time to revisit F. A. Hayek and The Road to Serfdom about the nature of command economies, and the nature of governments that impose them. Hayek supported social insurance programs, but warned that crafting them or anything else in the nature of a command economy would not just guarantee economic failure, but increasing lawlessness, arbitrariness, and tyranny from the government that imposes it as it gets desperate to avoid failure. That cycle appears to be fast-tracked with ObamaCare at Treasury.

As I say, I guess it’s too difficult to actually read Hayek’s Road to Serfdom, or his more complete Constitution of Liberty, to see what his argument actually was, so easier just to go with Judt’s comic book version instead. In both of his great books, Hayek endorses the principle of social insurance (and even a mandate for everyone to buy health insurance—egad*), but is concerned with the tendency toward making social insurance programs into redistribution programs. Wow—crazy stuff, I know. But you can see that Judt’s formula that Hayek opposed “welfare policies of any sort” is flat wrong.

And is Hayek’s broader point that centralized economic planning would lead to tyrannical government really so far-fetched? The linchpin of Hayek’s argument was that the plans and desires of the statists would require the undermining of the rule of law, because steadily increasing arbitrary power is necessary for their centralized schemes to work. I wonder whether Dionne has checked in lately with the Little Sisters of the Poor? Or has taken notice of the IRS harassment of groups opposed to Obama? I wonder what he makes of Obama’s unilateral executive decisions simply to suspend parts of the health care law that are politically inconvenient?

As for me, I wonder whether Scott expected his argument to be so very well validated in such a short space of time. Of course, no one expects the Treasury Inquisition …

HealthCare.Gov shutting down for maintenance — and just in time for Youth Enrollment day!

POSTED AT 6:41 PM ON FEBRUARY 11, 2014 BY ERIKA JOHNSEN

The Obama administration has been waging a steady and targeted campaign in their ever-vigilant quest to persuade young and healthy individuals to sign up for ObamaCare and hence assure that the system has the proper demographic mix to avoid the dreaded death-spiral scenario, but so far, the youth numbers just aren’t what they ought to be. As of mid-January, only about 24 percent of the system’s signups through 2013 were from the coveted 18-to-34 year old age group, and if the administration is going to convince the kids to do their bidding, they’re quickly running out of time as the March 31st deadline approaches.

As Red Alert Politics also points out, however, the big youth event seems to rather… er…oddly timed, via The Hill:

HealthCare.gov will be out of service for two and a half days beginning on Feb. 15 — the last day people can sign up to obtain coverage that begins on March 1.

The Centers for Medicaid and Medicare Services announced in a blog post on Monday that the ObamaCare website would be lacking some enrollment functionalities so the Social Security Administration can conduct its annual systems maintenance activities.

The site will be out of order from 3 p.m. on Feb. 15 until 5 a.m. on Tuesday — a period that coincides with the long holiday weekend.

Those seeking coverage by March 1 must have signed up online by Feb. 15, but with the website maintenance, those registering at the last minute won’t be able to find out what plans or subsidies they qualify for.

CMS is directing people to signup through the hotline while the site is down for the long weekend, but my question is why have it down through the weekend at all, rather than 3 A.M. on a Tuesday? Isn’t the weekend the time when most working people and students would have time to sit down and try to enroll, especially since, you know, you’re holding this huge youth outreach campaign the day of the deadline to “get covered” by March 1st? Maybe?

Twitchy......

President Euphemism! Obama calls latest Obamacare delay just an ‘adjustment’

As Twitchy reported, the White House recently announced yet another delay in the Obamacare employer mandate. And during today’s joint presser with French President François Hollande, intellectual acrobat Obama did his best to explain the extra-constitutional move — with a little help from the Euphemism Fairy, natch:

HealthCare.gov to be out of service

HealthCare.gov will be out of service for two and a half days beginning on Feb. 15 — the last day people can sign up to obtain coverage that begins on March 1.

The Centers for Medicaid and Medicare Services announced in a blog post on Monday that the ObamaCare website would be down so the Social Security Administration can conduct its annual systems maintenance activities.

The site will be out of order from 3 p.m. on Feb. 15 until 5 a.m. on Tuesday — a period that coincides with the long holiday weekend.

Those seeking coverage by March 1 must have signed up online by Feb. 15, but with the website down, those registering last-minute won’t be able to find out what plans or subsidies they qualify for.

The CMS is encouraging these users to call a hotline to complete the process.

In the first two months of ObamaCare, such outages were common-place, and set the administration well behind in its goal of having 7 million consumers signed up under the new healthcare law by March 31.

However, the website has been running smoothly for more than two months now, and there are signs that the final 2014 enrollment numbers may approach that original goal.

Consumers have until March 31 to sign up for a health plan in 2014, or face the penalty associated with the individual mandate.

One feature of Obamacare that Lambert has mentioned in passing in his posts is that individuals over 55 who are enrolled in Medicaid are subject to having expenses like being in a long-term care facility, home services, and related drugs and prescriptions clawed back from their estates. A must read post at Paul Craig Roberts details how pernicious and sneaky these provisions are.

The pilfering of assets of low-income Americans results from the interaction of several nasty features, and the article contends none of these were an accident (as in objections were made when the Affordable Care Act was being drafted and were ignored).

The estate recovery feature of Medicaid is pre-existing, from the Omnibus Reconciliation Act of 1993. But it didn’t seem to have much practical effect when it was added because Medicaid had an assets test which meant that people with meaningful assets were not eligible. As the article explains:

OBRA 1993 requires all states that receive Medicaid funding to seek recovery from the estates of deceased Medicaid patients for medical services received in a nursing home or other long-term care institution, home- and community-based services and related hospital and prescription drug services regardless of age. It also allows, at state option, recovery for all services used in the Medicaid state plan at age 55 or older. At minimum, states must pursue recovery from the probate estate which includes property that passes to heirs under state probate law, but states can expand the definition of estate to allow recovery from property that bypasses probate. This means states can use procedures for direct recovery from bank accounts and other funds. The state keeps a running tally, and even if you have a will, your heirs are chopped liver. Estate recovery can be exempted or deferred in certain situations after your death, but the regulations for this are limited and complicated with multitudes of conditions.

Now consider the ACA changes. First is that Obamacare expanded Medicaid eligibility. The ACA ended the asset test.

Second is that enrollment in Medicaid is now mandatory. If you or your family make less that 138% of the Federal poverty level, which in the 48 states and Washington DC would be $16,105 for an individual and $32,913 for a family of four in 2014 you are enrolled unless you fit in a short list of categories, such as being in jail, being in a state that opted out of Medicaid expansion, or being a member of an Indian tribe. You cannot opt out of Medicaid because you object to the estate recovery. You have to pay the penalty if you want out. And there are many routes by which you can become enrolled: by applying on an exchange and having it determine your income is too low to qualify for private insurance; by being in the SNAP (food stamps) database; by having an Obamacare plan but having a fall in income that puts you in the Medicaid category.

So if you have low income (by virtue of unintended early retirement, or even bad performance on your investment portfolio) but a decent level of assets, you can be caught in these provisions and have assets you had hoped to leave to family members instead taken by the government. And before you try arguing that that’s somehow fair, consider that the estate tax exemption is now $5.34 million. As the article points out:

Some might think it fair that those who are enrolled in Medicaid pay back the benefits they received. However, under a mandate that requires all Americans to be covered by health insurance or pay a tax penalty to the IRS, estate recovery is unconscionable since Obamacare offers no other viable option for this income-segment of the population. It also discriminates by age since only Medicaid enrollees who use benefits in the state plan at age 55 and up are subject to estate recovery, but those who use benefits at age 54 or less are home free unless they receive long-term care. Under federal law, discrimination is not permitted on the basis of age, but, obviously, the U.S. government turns a blind eye to to its own law. Perhaps, when states need more money due to the Obamacare expansion of Medicaid, and as the jobless economy continues causing more people to be eligible, age discrimination will be broadened to 45 and up.

But one of the most troubling elements is the lack of adequate disclosure about the estate clawback. Again from the article:

In June 2013 a letter was sent to the Centers for Medicare & Medicaid Services by a well-informed citizen pointing out that the Medicaid Manual prepared by CMS to provide guidance for states contains procedural rules intended to ensure that individuals are informed about estate recovery before they complete the application process.

There are variations in the ways in which states implement estate recovery, depending upon their Medicaid program and state laws. However, Federal law requires all states to incorporate the following protections for Medicaid recipients into the design of their estate recovery program:

— The State should notify Medicaid recipients about the estate recovery program during their initial application for Medicaid eligibility and annual re-determination process.
— The State must notify affected survivors about the initiation of estate recovery and give them an opportunity to claim an exemption based on hardship.
— The State must establish procedures and criteria to waive recovery if it would cause undue hardship.

The letter went on to say that the final CMS Health Insurance Marketplace application (healthcare.gov) notifies applicants about Medicaid’s right to pursue and recover any money from other health insurance, legal settlements or other third parties but does not disclose estate recovery. Since estate recovery is one of the terms of the Medicaid contract, it is deceptive to omit disclosure of this practice. CMS was asked to provide the reasons for this omission.

CMS responded evasively to the concerned citizen’s question. CMS claimed that the Health Insurance Marketplace application at healthcare.gov does not disclose Medicaid’s right to claim against the estate, because CMS wanted to provide flexibility to state Medicaid agencies as to how each one notifies applicants about estate recovery. Some states have developed pamphlets to address common estate recovery questions or devote a portion of a general Medicaid pamphlet to the subject. Some states also post their state plans, perhaps with additional explanatory text, on their web sites.

You can see the Catch-22 here. CMS puts the onus on states to make the notification, but people in the states that refused to set up exchanges apply through healthcare.gov. So consider this:

When you complete the application at healthcare.gov, it is assumed that when you submit it, you are fully informed and agree to all terms. Submission of the application is akin to signing a contract. Your signature not only means you have provided true answers to all the questions under penalty of perjury, but also that you understand and agree to all the rules and conditions. However, by not disclosing estate recovery CMS expunged your right to make an informed decision. Therefore, you may not realize that your estate can become government property because Obamacare forces you into Medicaid if your income is less than the threshold for a subsidized premium.

And here’s more state/Federal Catch-22:

Note that Obamacare applications contain a section titled Renewal of Coverage in Future Years. An applicant can agree to allow an exchange to use income data, including information from tax returns to automatically renew eligibility for 1, 2, 3, 4 or 5 years, or applicants can check “Do not use information from tax returns to renew my coverage.” Exchanges have access to the federal data hub which keeps track of your income and other personal data. If you gave unfettered access to your data by choosing auto-renewal, they have all the information needed to determine whether you are still eligible for your subsidized policy or should be moved into Medicaid.

The letter sent to CMS in June 2013 also asked about estate recovery disclosure in cases where coverage is auto-renewed during the annual redetermination process, when people are shifted from a subsidized plan to Medicaid due to a decrease in income or other change in circumstance, and when people are auto-enrolled on the presumption that they are eligible according to a database such as SNAP (food stamps) or by a hospital or health care center. A similar letter was sent to the Massachusetts Office of Medicaid.

The federal procedural rules on estate recovery say the state should notify Medicaid recipients about the estate recovery program during the annual redetermination process, but according to the Massachusetts Office of Medicaid, you don’t need to be informed about estate recovery during the redetermination process because you presumably read about this on the original application you filled out and submitted.

If you submitted an application that did not disclose estate recovery, it cannot be presumed that you are aware of estate recovery, because notification was not on the application. Thus, the redetermination procedure is one more example of the failure to disclose.

If you are bumped into Medicaid from a subsidized plan due to a change in your circumstances, the Massachusetts Office of Medicaid believes that you don’t need to be informed about estate recovery because you presumably read about this however many years ago when you filled out the original application. You will simply be sent a notice that you are now in Medicaid, and the notice will refer you to the Medicaid Member Booklet for information on the rules. If you obtain and read the booklet, you can learn that you may be subject to estate recovery. But don’t expect to receive a Medicaid Member Booklet with your notice, because “It would be cost prohibitive to include a Member Booklet with every notice. Instead, every notice includes information on how to contact Customer Service with any questions, including to request a copy of the Member Booklet.”

If these issues may be important to you or anyone in your family, I strongly urge you to read the post in full. It contains a great deal more important information. And it reminds us of how this is just another way to loot the public:

Obamacare was not written for the benefit of the poor and uninsured. It was written for the profits of the insurance companies giving them millions of new customers subsidized by U.S. taxpayers. The business of America is business. Private insurance company CEOs receive multi-million dollar pay packages, while under Obamacare low-income earners and the poor have to give up their homes and other assets in order to receive medical care.

2/10/14.....

There It Is: Obamacare Employer Mandate Delayed For Companies With Under 100 Employees

Specifically, according Bloomberg, businesses with 50-99 workers have until 2016 before being penalized for not providing health-care coverage to full-time workers, according to final regulations released by Treasury.

Additionally, businesses with 100 employees or more must offer coverage to at least 70% of full-time workers in 2015 and 95% in 2016; those that don’t will face penalty; Exemption in place for seasonal workers, those defined as generally at jobs 6 mos. or less/yr "While about 96 percent of employers are not subject to the employer responsibility provision, for those employers that are, we will continue to make the compliance process simpler and easier to navigate,” Asst Secretary for Tax Policy Mark J. Mazur says in statement e-mailed by Treasury. Furthermore, businesses with less than 50 employees are not required to provide coverage or fill out any forms in 2015.

... the only reason why Obama is suddenly willing to compromise over every aspect of his "crowning achievement" is that finally its tactical, and strategic failure has become clear for all to see. So it would be best to enact it piecemeal, and claim success for whatever legacy aspects of the system are working, while blasting everything that his unprecedentedly complicated, centrally-planned contraption has unleashed.

Finally, why three years? Because by then Obama will be gone (absent some very radical changes to presidential term rules), and Obamacare will be someone else's problem.

Then again Hillarycare sounds so much better than Christiecare.

And so Obama's crowning achievement is just a little less crowning. However, the true negative impact will be borne not by the current president but his successor... who will likely do the same and extend the full provisions indefinitely as well, as the last thing the struggling economy needs right now, as we have not tired of explaining for the past two years, is, well, Obamacare.

More color via Washington Post,

The Treasury Department rolled out Monday afternoon more tweaks to the health care law's requirement that all large employers--those with 50 or more workers--provide insurance coverage to their workers. This is the part of Obamacare was supposed to take effect at the start of 2014, but was delayed by the White House this past summer as the White House was facing significant push back from employers.

In today's final rule, the Obama administration is essentially relaxing the employer mandate for 2015--in a big way for medium-sized businesses, and a smaller way for the largest employers. Here's a rundown of the key changes.

1. Employers with between 50 to 99 employees get another year of transition.

The Obama administration will give medium-sized businesses another year's pass on providing insurance coverage to workers. Treasury estimates that about 2 percent of American businesses fall into this category, but does not have numbers on how many people work for businesses of this size. For these companies, the employer mandate does not take effect until 2016.

Employers who want to take advantage of this particular exemption will need to certify with the federal government that they are not cutting back on positions just to fall below the threshold. "It's simply so they don't game the system," one senior administration official told reporters on a phone call this afternoon. "They have to certify they're not doing that and not dropping their coverage."

2. Employers with 100 or more workers aren't required to cover everyone.

Previous regulations had required large employers to offer coverage to 95 percent of full-time employees to be considered in compliance with the employer mandate. Today, Treasury is ratcheting that requirement back: Large companies that offer coverage to 70 percent of their employees will be counted as fulfilling the employer mandate. This is a transitional measure and, by 2016, large employers will need to hit the original, 95 percent target. Treasury estimates another 2 percent of American businesses fall into this category, with more than 100 employees, but again, we don't have numbers on how many workers those companies employ.

3. Volunteers won't be counted as full-time employees.

There had been some tussling on Capitol Hill over whether certain volunteers - mostly volunteer firefighters - would count as full-time employees, for purposes of the health care law. Today's rule clarifies that they do not count as employees--which eliminates any incentives to get rid of volunteer positions.

There are other, smaller tweaks in the new Treasury rule that deal mostly with how, exactly, employers are supposed to count how many hours employees work (for seasonal workers, for example, or teachers, this can actually be a pretty difficult task.)

It's hard to to know how many people will be impacted by these changes since there isn't great data on how many people work for the different-sized employers.

* * *

Does this mean, according to inevitable WaPo fluff piece follow up to its ode to unemployment, that millions of workers will no longer get the privilege of being untethered from their jobs ?

Four Pinocchios to Durbin for claiming 10 million additional insured under ObamaCare

POSTED AT 10:01 AM ON FEBRUARY 10, 2014 BY ED MORRISSEY

Just how much spin can Dick Durbin fit into a single response? Yesterday on Meet the Press, Senator Durbin told Bob Schieffer that “the bottom line” on ObamaCare was that it would lower the deficit more than Democrats first claimed, and that 10 million Americans had gotten insurance through it and would otherwise be uninsured:

SCHIEFFER: Let me also ask both of you, more confusion, apparently, now, on — on health care. We now learn that the administration has told people, although they haven’t announced it publicly or hadn’t at the time, Senator Durbin, that if you don’t like your health care plan, in some cases, you can now switch and get another one. I mean, this thing just seems, every day, in every way, seems to me more confused. Is there any hope of getting it straightened out?

DURBIN: Bob, let’s look at the bottom line. The bottom line is this. Ten million Americans have health insurance today who would not have had it without the Affordable Care Act — 10 million. And we can also say this. It is going to reduce the deficit more than we thought it would. We were seeing a decline in the growth of the cost of health care, exactly our goal in passing this original legislation. I’m finding people, as I go across Illinois, who, for the first time in their lives, have an opportunity for affordable health insurance for their families. Now, there are many republicans who are wishing that this fails, hoping they can find any shred of evidence against it. But we had a bad rollout. Let’s concede that point. Since then, we are gaining steam. And I think, ultimately, we’re going to find you can’t go back. You have to extend the health insurance protection to the 25 million, 30 million Americans who will ultimately have it, and we’ll be a better nation for it.

First, the CBO report did not say that deficits would be lower than claimed because of ObamaCare. In fact, they warned of rapidly increasing deficits by the end of the current ten-year projection, after a small decline at present to, er, a half-trillion dollars — larger than any fiscal year in a George W. Bush-signed budget.

But more astonishing is the claim that 10 million people have insurance now that would not have had it without ObamaCare. In fact, the opposite is true — there have been fewer confirmed enrollments through ObamaCare than the number of people who have lost their existing insurance plans because of the changes. The absurd nature of this flat-out lie prompted the Washington Post’s Glenn Kessler to award Durbin four Pinocchios for the claim(via JWF):

Durbin went a step further and claimed that all of these people would not have had health insurance if not for the Affordable Care Act.

That’s simply ridiculous. For instance, members of Congress, such as Durbin, previously had health insurance and are now obligated to get it via the exchanges. But the problem goes deeper than that.

The Wall Street Journal in January detailed some of the surveys that have taken of people who obtained insurance through the exchanges, and the results so far indicate that the vast majority of enrollees were previously insured.

Durbin appears to have taken two dodgy claims from the White House and added them together — those signed up for plans through exchanges and the addition of 6.3 million people to Medicaid. The issue of sign-ups vs enrollments and the previous status of those actually enrolled is part of the problem with Durbin’s claim, but so is the Medicaid figure:

Meanwhile, just last Avalere threw cold water on the 6.3 million Medicaid figure, estimating that only 1.1 to 1.8 million of the enrollees could be attributed to the Affordable Care Act. That estimate generated headlines, including a full report in The Washington Post that said it suggested “many of the people who have joined the program since the initiative’s rollout in October would have done so absent the law.”

In other words, the Medicaid enrollment numbers are so suspect that, at this point, they should not be used in any formulation regarding the Affordable Care Act.

In fact, almost all of the numbers are suspect, thanks to the incompetence at HHS and the severe flaws of the exchanges. That’s the bottom line.

Is the new Healthcare.gov contractor worse than the first?

POSTED AT 8:41 AM ON FEBRUARY 10, 2014 BY ED MORRISSEY

Has HHS gone from the CGI Federal frying pan into the Accenture fire? A month ago, the HHS unit responsible for Healthcare.gov dumped its original prime contractor and awarded the project to Accenture in a no-bid assignment, a move that raised eyebrows especially considering how little time was left in the enrollment cycle to get the web portal problems resolved. Now, a new Washington Post report raises even more eyebrows about the decision, given Accenture’s troubled history with federal contracts:

Accenture, the contractor urgently tapped to help fix the federal health-insurance Web site, is a favorite of corporate America but has a record that includes troubled projects and allegations of ethical lapses, a review of the consulting giant’s history shows.

At the University of Michigan, students and faculty members are protesting the school’s use of Accenture to help cut costs, citing a report by a committee of alumni and graduate students that said the firm has “a disturbing pattern of problematic past performance.” In North Carolina, glitches in an Accenture-configured computer system contributed to massive backlogs for food-stamp recipients, leading the Obama administration last month to threaten to withdraw the state’s food-stamp funding. …

“Past performance was a key criteria when evaluating Accenture’s potential to serve as the new contractor,’’ said the official, who spoke on the condition of anonymity to discuss internal decision making.

But during the past decade, nearly 30 Accenture projects in the United States and abroad have encountered problems, including technical malfunctions and cost overruns, according to interviews, media accounts, government audits and other records.

Those aren’t the only problems Accenture created, nor the most recent. In June of last year, just seven months before HHS would grant them the no-bid contract for ObamaCare, the Inspector General of the US Post Office recommended canceling all of Accenture’s contracts for “an absence of business ethics”:

The U.S. Postal Service should consider suspending or debarring one of its largest contractors, information technology firm Accenture, from future work because of the risk of fraud, the agency’s inspector general said in a newly released audit.

Accenture “has demonstrated an absence of business ethics, a lack of transparency and insufficient internal controls in its business dealings with the Postal Service,” according to the audit, which also cited Accenture’s $64 million settlement two years ago with the Justice Department to resolve kickback allegations stemming from its hardware and software recommendations to other agencies. Besides potentially cutting off future business to Accenture, the Postal Service should consider ending existing contracts, the IG said.

The audit comes six months after the inspector general concluded in a separate review that Accenture wasn’t attempting to fix its system for tracking actual contract costs in comparison with estimated costs and hadn’t fully addressed an earlier recommendation to periodically review its estimating system.Under a suspension, the firm would be barred from USPS contracting and subcontracting for one year; a debarment could last up to three years.

Several sources tell the Post’s Jerry Markon and Alice Crites that Accenture was “probably” the best choice to rescue Healthcare.gov, and that “past performance was a key criteria” in their selection. If that’s the case, then we’re in a lot more trouble than we think. The bestoption that the government had was a firm so ethically challenged and dogged with failure that the US Post Office wanted them fired? And how exactly does a no-bid process ensure that there were no better options, anyway?

If that’s true, then we have yet even more evidence that the federal government is uniquely incompetent to manage anything on this wide of a scale.

And....... From Twitchy

*****

Delay? Say it ain’t so! CBS and Slate correspondent John Dickerson sure as hell didn’t see this coming:

We know that as liberty-minded folks, we’re basically just ignorant rubes. But it seems to us that if parts of Obamacare keep getting delayed, maybe, just maybe, the whole damn thing should be scrapped.

U.S. says Social Security computer outage to affect HealthCare.gov

2 hours ago

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A busy screen is shown on the laptop of a Certified Application Counselor as he attempted to enroll an …

WASHINGTON (Reuters) - The Obama administration on Monday said people hoping to enroll in health coverage for March 1 may have trouble applying by Saturday's deadline because of a planned 62-hour maintenance shutdown of a Social Security Administration computer system.

The U.S. Centers for Medicare and Medicaid (CMS), the lead Obamacare agency, said the shutdown will prevent applicants from verifying their Social Security numbers and other data through the federal website, HealthCare.gov. Those unable to enroll because of the outage can request special enrollment for coverage beginning March 1, CMS said.

The Social Security computer system will be down from 3 p.m. EST (2000 GMT) on Saturday until 5 a.m. EST (1000 GMT) on Tuesday, February 18, CMS said. CMS said those who have already completed an application will still able to shop or select a plan through the website.